Lifting the lid on toilet plume aerosol: a literature review with suggestions for
future research.

Abstract

BACKGROUNDThe potential risks associated with "toilet plume" aerosols produced by flush toilets
is a subject of continuing study. This review examines the evidence regarding toilet
plume bioaerosol generation and infectious disease transmission.METHODSThe peer-reviewed scientific literature was searched to identify articles related
to aerosol production during toilet flushing, as well as epidemiologic studies examining
the potential role of toilets in infectious disease outbreaks.RESULTSThe studies demonstrate that potentially infectious aerosols may be produced in substantial
quantities during flushing. Aerosolization can continue through multiple flushes to
expose subsequent toilet users. Some of the aerosols desiccate to become droplet nuclei
and remain adrift in the air currents. However, no studies have yet clearly demonstrated
or refuted toilet plume-related disease transmission, and the significance of the
risk remains largely uncharacterized.CONCLUSIONResearch suggests that toilet plume could play a contributory role in the transmission
of infectious diseases. Additional research in multiple areas is warranted to assess
the risks posed by toilet plume, especially within health care facilities.